Strengthening U.S. Jail Systems’ Response to Infectious Diseases: An Evaluation of the COVID-19 Pandemic

Author

Erinn Bacchus, CUNY School of Public HealthFollow

Date of Degree

6-1-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy (Ph.D.)

Department

Community Health and Social Sciences

Advisor(s)

Nicholas Freudenberg

Committee Members

Emma Tsui

Naomi Zewde

Robert Fullilove

Subject Categories

Community Health | Community Health and Preventive Medicine | COVID-19 | Criminology | Inequality and Stratification | Public Health | Public Policy | Social Justice

Keywords

COVID-19, pandemic, Jails, incarceration, preparedness plans, reentry

Abstract

Jails across the United States were struck with increased infections and deaths during the COVID-19 pandemic. Studies have shown the structural make up of jails, lack of preparedness plans, and overcrowding contributed to health risks and poor health outcomes both inside jails and local communities. Yet little research has been dedicated to strengthening jail responses to infectious disease outbreaks spanning prevention measures, data collection, and reentry planning. Gaps include information on the (1) myriad infectious disease mitigation strategies used in jails and adherence to CDC prevention guidelines, (2) development of a standardized epidemiologic surveillance system, and (3) experiences working at reentry organizations and utilizing services during an infectious disease outbreak. The COVID-19 pandemic offered a unique opportunity to explore these issues. The dissertation aimed to address each of the research gaps outlined above.

I conducted a content analysis of news, government, and organizational documents to identify similarities and differences among three regionally disparate jail systems (New York City, Los Angeles, and San Antonio) to better understand the breadth of procedures used in mitigating the spread of COVID-19 inside jails and to inform future infectious disease preparedness plans (Aim 1). In addition to describing the variety of strategies used, I reviewed the strategies recommended by the CDC for management of COVID-19 in correctional facilities to determine if each was implemented among the three jail systems. A total of 23 documents were reviewed. I found that each jail engaged in many similar strategies including limiting movement, providing PPE, administering healthcare, educating staff and jail residents, enhanced cleaning, and decarceration. However, only two out of the five recommended guidelines outlined by the CDC were followed these included administering testing upon intake or requiring an observation period as well as providing and using masks.

I also conducted a qualitative surveillance analysis of the data collection and reporting system created as part of UCLA’s COVID Behind Bars project to better understand its successes and determine potential improvements for a standardized comprehensive infectious disease data collection system inside jails that is capable of accurately assessing the health of people incarcerated (Aim 2). The analysis followed the CDC’s updated Field Guidelines for Evaluating Surveillance Systems. I found that the surveillance system provided the essential building blocks needed to develop a standardized and comprehensive jail health data system. With respect to the specific assessments referenced in the CDC’s surveillance evaluation framework the current analysis finds the system to be simple, flexible, stable, and to likely have a high positive predictive value. However, due to the uneven quality and completeness of COVID-related data in jails, sensitivity could not be statistically confirmed.

The final part of this dissertation drew on 10 in-depth interviews with reentry organization personnel to explore the services and programs offered during the pandemic as well as examine to what extent the pandemic affected the perception of reentry and purpose of reentry organizations. To complement these perspectives, interviews with individuals formerly incarcerated during the COVID-19 pandemic, were used to investigate the perceptions and experiences of people who returned to their communities from NYC jails and explore to what extent the pandemic influenced their experiences across domains including health, housing, work, and social relationships (Aim 3). Participants discussed the importance of housing and occupational services during the pandemic and the decision to move services remote or remain in-person. Reentry staff also emphasized their commitment to reentry work while formerly incarcerated persons showed their deep appreciation for this work highlighting the importance of supporting and providing resources for reentry organizations.

Findings from this dissertation prompt reconsideration of mass incarceration, its racist underpinnings, and its social and economic costs. Together, these results make the case for increased public health focus on infection mitigation in jails. At its core, this is a health equity issue. People of color and other marginalized populations like those of lower income and education, individuals with mental health and drug use problems, and immigrants are overrepresented in our carceral system. People who are incarcerated also often suffer from health conditions that increase their risk of infection and suffer worse outcomes including death. To promote the health of incarcerated populations as well as the greater community, we should address the gaps in infectious disease preparedness by codifying the establishment of preparedness plans and the collection of relevant health data as a minimum standard for health in prisons and jails. We should also prioritize reentry services by offering a minimum set of reentry services, through jail facilities and independent reentry organizations who should be supported through increased and sustained funding. Finally, reducing jails populations should be addressed through bail reform laws and other mechanisms like replacing larger jail facilities with fewer, smaller jails.

Recommended Citation

Bacchus, Erinn, "Strengthening U.S. Jail Systems’ Response to Infectious Diseases: An Evaluation of the COVID-19 Pandemic" (2024). CUNY Academic Works.
https://academicworks.cuny.edu/sph_etds/107